Before treatment:
Bill felt his balance function was worse than before when he was skiing 4 years ago. His condition became worse, he couldn’t walk well and his steps were wider than normal so he went to a local hospital and was diagnosed with ataxia. His disease became worse but went untreated. He couldn’t move his arms well, his fine motor movements were bad meaning it was difficult for him to write. His speaking became slurred in the last 2 years. His swallowing function was normal but when drinking water he choked. He went to another hospital in 2015 and was diagnosed with multiple system atrophy. For now, his balance function is bad but he is able to turn over, sit up, stand and walk by himself. He is unable to walk well though so he walks slowly and his steps are wider than normal. There is stiffness in his arms. He can still take care of himself now but his fine motor movement that allow writing and speaking are all bad. He wants to have a better life so he came to our hospital and was diagnosed with ataxia.
His appetite, eating, sleeping, bladder and bowel actions are all normal.

Admission PE:
Bp: 140/89mmHg, Hr: 65/min, breathing rate: 20/mim, body temperature: 36.3 degrees. His height is 171 cm; weight 56Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion, and his tonsils are not swollen. The respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and with no obvious murmur in the valves. The abdomen was flat and soft, with no masses or tenderness. The liver and spleen were normal. The spinal column is normal and there was no swelling in either leg.

Nervous System Examination:
Patient was alert and his facial expression was natural but with slurred speech. His memory, orientation and calculation ability were normal. Both pupils were equal in size and round with a diameter of 2.5 mm. The eyes react well to light and the eyeballs can move freely. There is no nystagmus. Bilateral forehead wrinkle and nasolabial fold are symmetrical, he can close eyes tightly and show teeth as normal. He can chew food normally but while he had some jerking movement when eating and drinking the lower jaw movement is normal. Tongue muscles do not have tremor and his tongue can touch the cheek strongly with the patient able to bulge his cheek strongly. He can turn his neck freely and shrug his shoulders strongly. Muscle power of the arms is 5 degrees There is no Wax-Waning Sign, no static tremor and he only had mild difficulty to write. Muscle power of the legs is 5 degrees, he can stand up, roll over in bed and sit up himself. He had an abnormal gait when walking due to his step width. He cannot walk straight and he cannot stand on one leg. He had normal muscle tone in all 4 limbs but tendon reflex was impaired. His abdominal reflex cannot be induced also. The bilateral palm-jerk reflexes are positive and the pathological sign was positive. Deep and superficial sensation examinations are normal. Fingers to nose test is not very stable but he can perform the fast alternative movement and fingers opposite movement slowly. Heal-knee-tibia test was clumsy. His Romberg's sign is positive. Meningeal irritation sign was negative.

Post-treatment:
After 12 days of treatment his balance control ability is better than before, his gait when walking or turning around is better. He could finish the finger-to-nose test more easily. His speech is clearer and his jerking movement has reduced.